WHO IS TREATING WHOM ?

I have been focusing on the economic driven “providers” reaction to Obama care and how it will impact on the health care that will be available to us. Before I focus on institutional and service impaction I will call your attention to the proposed budget plan the President has sent to Congress  

The plan would replace the automatic, across-the-board cuts called sequestration that include a 2% decrease in Medicare reimbursement for physicians.

In addition, as in previous budget plans, Obama would perform a "doc fix" on the sustainable growth rate (SGR) formula for setting Medicare pay rates. That formula, hated by organized medicine, will trigger a 24.4% cut in physician pay on January 1, 2014, unless Congress steps in to prevent a collapse of the federal program. Under the Obama plan, physician pay rates would be frozen at their current level. The administration supports several years of fee-for-service "payment stability" that would give the Centers for Medicare & Medicaid Services more time to develop various pay-for-performance models from which physicians eventually could choose. The goal is to "provide predictable payments that incentivize quality and efficiency in a fiscally responsible way," the budget plan states.

As expected, Medicare spending gets trimmed substantially — $370 billion worth over the course of 10 years — but the cuts come mostly at the expense of hospitals, drug companies, nursing homes, and wealthy seniors, who will be asked to pay higher premiums. Obama refrained from raising the eligibility age for Medicare; an idea toyed with in Washington, DC.

"Clarification"; the  annual reimbursement rates proposed under the SRG formula have annual resulted in either a less than a COLA formula adjustment and more often a decrease in allowed fees; the large reduction was written in the last compromise bill passed to justify an increase in the debt limit. It was to go into effect a few years ago but at the last minute Congress has passed legislation postponing that reduction. However the threat is there, which is why more physicians are entering employment in commercial groups many sponsored by hospitals who wish to gain by a bigger potential patient base and also to profit in the lucrative radiology and laboratory testing markets along with ancillary services such as physical therapy.

It is in those ancillary services from both in and outpatient sources plus more sophisticated coding for MD services that the hospitals hope to increase their income. Institutions will also be under contract to provide all the aspects of patient services including the physician.There is little rational between the costs of most laboratory tests and the fees allowed by Medicare much less than charges made to the uninsured.  Institutions reimbursement from human provider services using sophisticated coding templates will be greater than the wages paid employed health personnel. All add up to profitable income for so called non-profit hospital corporations.

Medicare and Medicaid’s cost savings will come from limiting procedure services either by the number of procedures allowed per month or by the availability of expensive procedures.It is not inconceivable that exotic innovative equipment will have to be licensed and the number controlled.

Other cost saving aids will be by limiting the number of available beds by closing hospitals or not permitting expansion. The big groups and hospitals will rely more on low cost care givers such as NPs and PAs instead of MDs for care in low risk and primary areas.  

The Feds are making it easier and profitable for non on hands physician primary care. As an example; The Insurance companies are making deals to reduce their costs and to tier payments to various provider. The Rite Aid Drug Stores Now Clinic Online Care program is now available at 58 locations in four cities: Baltimore, Boston, Philadelphia and Pittsburgh. Customers can consult with doctors by video or phone or through an online chat about a range of ailments. A 10-minute consultation costs $45. (WSJ 3//13).

Once again the heads in the clouds boys & girls know that the laying on of hands or personal contact is not needed to treat illness. Now it can all be done by cellphone, Internet, social media or VoIP. In some cases a computer programed to answer key phrases could be at the correspondent end.

On the other hand this past week WSJ had a section devoted to health care in which it emphasized the importance of personal communication between doctor and patient. The ability of the patient to relate to the therapist; to ask questions and receive understandable answers was one of the biggest factors in treatment success reducing lack of compliance and failures. That in the end results in reducing health care costs.

Next the EHR flimflam.